A controlled trial of substrate-enhanced, warm reperfusion (“hot shot”) versus simple reperfusion

• Published in: The Annals of thoracic surgery Vol. 69; no. 2; pp. 551 - 555
• Main Authors: Edwards, Rhian, Treasure, Tom, Hossein-Nia, Mojgen, Murday, Andrew, Kantidakis, George H, Holt, David W
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2000; Elsevier Science
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Creatine Kinase - blood; Heart Arrest, Induced; Humans; Isoenzymes; Medical sciences; Middle Aged; Myocardial Reperfusion Injury - prevention & control; Reperfusion - methods; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Troponin T - analysis; Human; Cardiovascular disease; Replacement; Heart valve; Coronary heart disease; Concomitant disease; Reperfusion; Treatment; Aortocoronary; Cardiac valvular disease; Bypass; Surgery; Technique; Hypothermia
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(99)01325-9

Background. Modified reperfusion after aortic cross-clamping is claimed to reduce myocardial injury, thus improving postoperative myocardial performance. Methods. We measured perioperative release of creatine kinase-MB and troponin-T in 40 patients undergoing valve replacement (combined with coronary grafts in 12 cases) to determine whether infusion of a modified reperfusate before cross-clamp removal reduced myocardial injury. Patients were randomly allocated to one of two groups with minimization for age, surgeon, operation, and ventricular function. The control group received unmodified reperfusion, while the study group received a normothermic reperfusate, enhanced with glutamate and aspartate, for 5 minutes before removal of the cross-clamp. Serial determinations of troponin-T, creatine kinase-MB isoforms, and total creatine kinase-MB activity were made up to 5 days postoperatively. Requirements for inotropic support and evidence of myocardial infarction were documented. Results. Creatine kinase-MB activity, creatine kinase-MB isoforms, and troponin-T were not significantly different between the two groups. There were no differences in the incidence of postoperative myocardial infarction or in inotrope requirement. Conclusions. Our study did not demonstrate any advantage in using modified reperfusion in this group of patients.